PUBLIC HEALTH LEADERSHIP FOR ACTION ON HEALTH EQUITY: …nccdh.ca/images/uploads/comments/Public_health_leadership_for_a… · Public health leadership is defined by the Public Health

PUBLIC HEALTH LEADERSHIP FOR ACTION ON HEALTH EQUITY: A LITERATURE REVIEW

LEADERSHIP FOR HEALTH EQUITY

Contact InformationNational Collaborating Centre for Determinants of HealthSt. Francis Xavier UniversityAntigonish, NS B2G [email protected]: (902) 867-6133fax: (902) 867-6130www.nccdh.caTwitter: @NCCDH_CCNDS

The National Collaborating Centre for Determinants of Health is hosted by St. Francis Xavier University. We acknowledge that we are located in Mi’kma’ki, the ancestral and unceded territory of the Mi’kmaq people.

Please cite information contained in the document as follows:Betker, RC and the National Collaborating Centre for Determinants of Health. (2018). Public health leadership for action on health equity: A literature review. Antigonish, NS: National Collaborating Centre for Determinants of Health, St. Francis Xavier University.

ISBN: 978-1-987901-88-7

Production of this document has been made possible through a financial contribution from the Public Health Agency of Canada through funding for the National Collaborating Centre for Determinants of Health.

The views expressed herein do not necessarily represent the views of the Public Health Agency of Canada. This document is available in its entirety in electronic format (PDF) on the National Collaborating Centre for Determinants of Health website at www.nccdh.ca.

La version française est également disponible au www.ccnds.ca sous le titre Leadership de la santé publique pour favoriser l’équité en santé : une revue de la littérature.

1

ACKNOWLEDGEMENTS

This paper was authored by Claire Betker and Dianne Oickle.

Reviewers

• Sume Ndumbe-Eyoh, Knowledge Translation Specialist, National Collaborating

Centre for Determinants of Health

• Gaynor Watson-Creed, Deputy Chief Medical Officer of Health, Nova Scotia Health

Authority

THE NATIONAL COLLABORATING CENTRE FOR DETERMINANTS OF HEALTH

The National Collaborating Centre for Determinants of Health (NCCDH), hosted by

St. Francis Xavier University, is one of six National Collaborating Centres (NCCs) for Public

Health in Canada. Funded by the Public Health Agency of Canada, the NCCs produce

information to help public health professionals improve their response to public health

threats, chronic disease and injury, infectious diseases and health inequities. The NCCDH

focuses on the social and economic factors that influence the health of Canadians and

applying knowledge to influence interrelated determinants and advance health equity

through public health practice, policies and programs. Find out more at www.nccdh.ca.

The other Centres address aboriginal health, environmental health, healthy public policy,

infectious disease, and methods and tools. Find out more about all NCCs at www.nccph.ca.

PUBLIC HEALTH LEADERSHIP FOR ACTION ON HEALTH EQUITY: A LITERATURE REVIEW

PUBLIC HEALTH LEADERSHIP FOR ACTION ON HEALTH EQUITY: A LITERATURE REVIEW2

Introduction

Strong and effective leadership in public health is

essential to improve health equity, both operationally

and ideologically. A leader’s commitment to

social justice values is necessary to address the

socioenvironmental factors that determine differences

in health within and across populations. This

commitment is demonstrated in a leader’s everyday

actions, behaviours and decisions.1 Embedding equity

within formal and informal leadership structures is a

foundation for organizational capacity and readiness

to take action on health inequities.2

The National Collaborating Centre for Determinants

of Health’s (NCCDH) environmental scans conducted

in 20103 and 20144 revealed that the development

of effective leadership for health equity is a priority

area for public health.a Leadership was recognized as

essential to influence policy, priority setting, resource

allocation, partnership and collaboration, as well as

the implementation of health equity interventions.

However, leadership for health equity in public health

systems was perceived as being inconsistent and

at times absent across jurisdictional contexts and

organizational levels. An important finding in both

scans was the apparent disconnect between the

commitment and intent expressed by leaders and

the tangible actions taken to advance health equity

in communities and populations.

In 2016, a scoping review and metasummary on public

health leadership for action on health equity was

completed as a PhD dissertation research project.b,1

As part of the dissertation research, a comprehensive

literature review was conducted to help refine

the research questions and inform the analytical

framework for the subsequent scoping review.

An important finding of the literature review was that

there is very little theoretical and empirical literature

examining public health leadership to take action on

health inequities, making the definition, development

and support of leadership in this area very challenging.

The literature review did, however, provide important

insights that are relevant to public health equity action

and are explored in this summary, including:

elements and theories of leadership;

distinguishing followers and leaders;

differentiating leadership and management; and

considering leadership at all levels.

This summary highlights key concepts from the

general leadership literature that are transferrable

and can inform public health action on health equity.

The NCCDH collaborated with the author to produce

a summary of the literature review.c The results

of the full scoping review are explored in a second

document,d including what the literature identified as

essential leader attributes and strategies to support

and develop public health leadership to take action on

health equity.

Public health leadership to advance health equity: A scoping review and metasummary (2016)

The full dissertation Public health leadership

to advance health equity: A scoping review and

metasummary by Dr. Claire Betker1 addresses

the dearth of literature supporting action by

public health leadership on health equity. It

can be found in the NCCDH online Resource

Library at www.nccdh.ca/resources.

a The NCCDH’s 2017 environmental scan, to be released in March 2018, emphasizes leadership and organizational capacity to advance health equity and public health’s interface with the larger health system.

b This research was initiatied when the dissertation author, Dr. Claire Betker, was an NCCDH staff member and the NCCDH acted as a valuable collaborator in the formative and early stages of the scoping review research.

c This document is a summary of the literature review portion of a larger scoping review research project. The complete literature review can be read as part of Dr. Claire Betker’s dissertation1 at http://nccdh.ca/resources/entry/public-health-leadership-to-advance-health-equity-a-scoping-review-and-meta.

d This second document will be available in March 2018.

3PUBLIC HEALTH LEADERSHIP FOR ACTION ON HEALTH EQUITY: A LITERATURE REVIEW

What the literature says about public health leadership for action on health equity

Let’s Talk: Health equity (2013)

Let’s Talk: Health

equity explores how

the concept of health

equity applies to

public health practice. PART OF THE LET’S TALK SERIES

LET’S TALK

H E A LT H E Q U I T Y

The literature review revealed a very interesting

situation regarding the status of the literature on

public health leadership for action on health equity.

While there was a large body of writing on leadership

from many sources, including academic research, grey

literature and opinion-based writing that can be applied

across professions and structures, the presence of

literature on public health leadership was limited. Much

of what was available counted as secondary sources,

including opinion pieces, commentaries and some grey

literature. There was even less writing on public health

leadership to address health equity specifically.

Description of leadership

Public health leadership is defined by the Public Health

Agency of Canada (PHAC) as follows:

The ability of an individual to influence, motivate,

and enable others to contribute toward the

effectiveness and success of their community and/

or the organization in which they work. It [public

health leadership] involves inspiring people to

craft and achieve a vision and goals. Leaders

provide mentoring, coaching and recognition.

They encourage empowerment, allowing other

leaders to emerge.5(p12)

In short, leadership is about “influence that moves

individuals, groups, communities and systems toward

achieving goals that will result in better health.”6(p31)

While there was literature describing the

characteristics of effective leaders in other sectors,7-9

literature examining public health leadership and its

effectiveness was not available. “Effective leadership”

in other sectors was described as visionary, with

leaders acting intentionally and using skilled

communication to turn vision into action,10 as well

as being able to motivate people and generate the

energy required to cope with change.11 Leadership

was described in relation to followers, peers,

supervisors, organizations, settings and culture.12,13

More recent descriptions of leadership found in

the literature were less focused on the individual,

highlighting the shift to viewing leadership outside

the attributes of a single person. Leadership was

described as shared, distributed, relational, complex,

social, situational and dynamic.12,13 Broad leadership

attributes were described as proximal (expertise,

knowledge, communication and problem-solving

skills) and distal (values, cognitive abilities and the

personality of the leader).14

A focus on social justice and the use of evidence,15

as well as the ability to align different views into a

common mission,16 were significant when it came

to strengthening the value system of a public

health organization. Vision, values, communication,

relationships and the abilities to make change happen

and renew followers were considered essential

elements of leadership.10 The ability to communicate

with a wide variety of audiences,17 alongside skills

related to conflict resolution,18 negotiation18 and

collaboration,19 were also considered necessary

for effective leadership. Moreover, an appreciation

for when change is needed, including the value

of incremental change, or when the status quo


is preferable, combined with a solutions-focused

approach, was seen as an important aspect of a

leader’s role.10,20 Finally, the ability to maintain and

develop relationships,21 including attention to external

influences through partnerships and networks, was a

key feature relevant to public health leaders.

A focus on social justice and the use of evidence,15 as well as the ability to align different views into a common mission,16 were significant when it came to strengthening the value system of a public health organization.

“

”Theories of leadership

Many leadership theories were identified by authors

as being applicable to public health settings. For

example, the review of the literature highlights three

leadership theories that are particularly applicable

to public health practice. Transcendent leadership

has a focus on “leadership of self,”22 where leaders

are aware of their own biases, prejudices and

weaknesses.23 It works through dialogue, shared

understanding and collective decision making.23,24

The five practices of exemplary leadership model25

outlines five essential practices of leaders as

follows: modelling the way, inspiring a shared

vision, challenging the process, enabling others

to act, and “encouraging the heart” by recognizing

achievements and showing appreciation to others.

Complexity leadership theory26 describes leadership

that adapts to changes in people and systems

(adaptive), aligns the actions of individuals and

groups (administrative) and facilitates the flow of

knowledge and processes (enabling) between levels

of an organization, as well as between communities

and organizations.

Taking a closer look

A critical analysis of the literature revealed several

key areas that merit deeper consideration for

how they apply to public health leadership action

on health equity. The following section highlights

literature findings for three of these areas, including

the relationship between leaders and followers, the

distinction between management and leadership,

and the roles leaders play at various levels within

an organization.

Leaders and followers

Relationships between leaders and followers matter.

Because leaders need to appeal to what motivates

and drives their followers, a relationship develops

between them.27 The integrity of the relationships

between leaders and followers determines how they

work together towards achieving common goals25

through shared power and joint participation.28 Being

an effective leader demands investing in individuals

and teams (followers). When leaders mentor, act as

role models, precept and offer individual attention,

it represents an investment in the interdependent

capacity of followers and of leaders themselves.10,25,29

Effective leadership is necessarily balanced with

followership within and between public health

organizations, systems and practitioners.30,31

Followership refers to the demonstration of courage,

credibility and commitment to a purpose outside

the individual29 while demonstrating a high degree

of teamwork.32 It is important for leaders to enable

these skills among staff, and to be effective followers

themselves.


Management and leadership

The relationship between managers and leaders

is a critical element of public health practice. The

terms management and leadership are often used

interchangeably to describe positions of authority

in an organization, though their formal roles can

be quite different. Management most often focuses

on the administration of regular activities,10 such

as the implementation of public health programs

and interventions. Leadership provides vision in the

development of organizational and program goals,

objectives and strategy.11 However, leadership tasks

may have a management component, such as priority

and agenda setting,33 and those in management

positions often have leadership roles,10 such as

motivating and aligning staff. In other words, a

manager can also be a leader, and a leader can

also manage.

It is the pairing of a leader’s vision with leadership

skills that enables them to implement and sustain

change.34 The tasks of planning, budgeting,

organizing, staffing, scheduling and implementing are

needed to support action resulting from the original

vision. After a project’s or organization’s vision is

defined, the tasks of agenda setting, aligning people

and bringing communities together are also needed

to direct the various processes at hand. In this way,

leaders and managers are symbiotic.

Leadership at multiple levels of the public

health system

The nutcracker effect35 is a concept that describes

how commitment within policy, political and decision-

making structures at the top — when combined with

bottom-up demand for action from civil society —

creates sufficient pressure to influence the forces that

determine health inequities. When a public health

leader works with multiple stakeholders at the system,

political and local levels, it encourages meaningful

participation that influences the assessment,

development and implementation of policy and

interventions.21 Coordinated leadership at local,

regional, national and international levels that includes

(but is not limited to) the public health sector can

influence health equity.16 Partnerships are nurtured by

public health leaders through skilled communication

and the empowerment of community leaders.37

What this means for action by public health leadership on health equity

Leadership within a public health system spans

professions, disciplines and positions and is not

isolated to a job title. Several key learnings emerged

from the review of the literature supporting the

development of public health leaders to advance

health equity.

What contributes to successful public health leadership for health equity? An appreciative inquiry (2013)

The NCCDH

publication What

contributes to

successful public

health leadership

for health equity? An

appreciative inquiry

provides an overview

of factors and conditions that should be

considered to support action on health equity.

WHAT CONTRIBUTES TO SUCCESSFUL PUBLIC HEALTH LEADERSHIP FOR HEALTH EQUITY? An Appreciative Inquiry

SUMMARY

“ Health inequalities are fundamentally societal

inequalities that we can overcome through public

policy, and individual and collective action” 1

Dr. David Butler-Jones, Chief Public Health Officer of Canada


The empowerment of leaders at multiple levels of

the public health system is possible

Leadership can occur at all levels of the public health

system12 and leadership competencies for public

health practice apply across organizational positions

and professions.38 Attributes such as skill, knowledge

and expertise strengthen leadership at any level of an

organization,31 and as such, leadership responsibility

and accountability are not simply formalized in job

descriptions or organizational plans.39 Public health

leaders understand that quick fixes to complex public

health issues are not feasible, and that they need to

be dedicated to long-term processes with incremental

movement and results.22

Public health leadership that reflects the core values

of health equity and social justice is characterized by

relationships, innovation and a focus on collaboration

and partnership development.40 Empowering

leadership, whether in formal positions of authority

or among front-line staff, is only possible when

the individuals in these positions have the skills,

knowledge and authority to make decisions when

representing the organization.25 Supporting the

development of relational skills such as commitment

and integrity among public health practitioners at

all levels strengthens leadership capacity in public

health organizations.

Organizational culture that supports the values,

assumptions and behaviours necessary for

momentum on health equity facilitates public health

practitioners to be effective in leadership positions.2

Both the external environment and the formal and

informal systems of an organization can support

or undermine its members, including leaders.41

The successful development of leadership skills at

any level depends on organizational supports for

practice, role clarity and a defined scope of practice,40

in addition to ensuring that adequate resources and

processes exist so public health staff can practice

these skills.

Collective impact and public health: An old/new approach — Stories of two Canadian initiatives (2017)

Collective impact

is a collaborative

community

development approach

in which public health

can be involved in

projects to achieve

social change. Our

case study titled Collective impact and public

health: An old/new approach — Stories of two

Canadian initiatives offers an in-depth portrait

of two Canadian organizations that have used

this strategy.

COLLECTIVE IMPACT AND PUBLIC HEALTH: AN OLD/NEW APPROACH – STORIES OF TWO CANADIAN INITIATIVES

PART OF THE

LEARNING FROM

PRACTICE SERIES

Public health leadership is relational

The concept of being relational can be applied to

both leadership and integrity, and both are central

to leadership practice in public health. Relational

leadership is rooted in how leaders see their place

in the world, how they hold themselves morally

accountable to issues and other people and are

always “in relation with” other issues rather than

being separate from them.39 Relational integrity,

on the other hand, refers to the need for leaders

to be responsive to what is going on around them,

to recognize that they are influenced by their

environment and to realize that formulaic answers

don’t work for every situation. The term also refers to

the leader’s personal values and morals and how the

leader responds in times of uncertainty and doubt.39


Public health leadership occurs in a multi-sectoral, relational and dynamic environment, which influences the actions that can be taken and makes strong and ongoing relationships necessary.

“

”The values and morals of leaders at all levels

establish the culture of public health organizations

as a whole, providing the space for the issues that

are prioritized for action. The interactions between

leaders and those they work with are shaped by

the context of the organizational environment.42

Public health leadership occurs in a multi-sectoral,

relational and dynamic environment, which influences

the actions that can be taken and makes strong and

ongoing relationships necessary.

Learning Together series (2012)

Our Learning

Together series on

population health

status reporting

explores the use of

indicators to inform

public and population

health policies.

ABOUT THE POPULATION HEALTH STATUS REPORTING INITIATIVE

The National Collaborating Centre for Determinants of Health

(NCCDH) is working with Canadian public health organizations

and practitioners to improve the methods used to produce

population health status reports. Through the Population

Health Status Reporting Initiative, the NCCDH aims to better

illuminate health inequities and support the development of

effective and equitable policies.

OBJECTIVES

1. Learn about how to effectively integrate an equity lens into

public health surveillance and reporting

2. Model innovative and collaborative practice in learning and

evaluation related to the integration of health equity into

population health status reporting

3. Support Capital Health (Halifax, Nova Scotia) in the development

of a high quality and effective population health status report

that effectively integrates and communicates equity issues

4. Share learnings from the project in accessible and

innovative ways

This document summarizes the National Collaborating Centre for Determinants of Health (NCCDH) Population Health Status Reporting Initiative.

LEARNING TOGETHER:COLLABORATING TO IMPROVE POPULATION HEALTH STATUS REPORTING

Population health status reporting is a vital tool for addressing the social determinants of health and advancing health equity. The way that health data is collected and shared shapes our perception of population health. Public health practitioners and organizations from across Canada have identified the need for resources, tools, and collaborative learning on this topic.1

Leaders can use data to demonstrate inequities

One of the unique contributions of public health

leadership when it comes to collaborative work on

health equity is the ability to demonstrate where

inequity is present. Public health leaders who

use “new methods of integrating and displaying

data, telling evidence-based stories, and engaging

communities in the design and planning of research

and programs”43(p19) will make decisions about

strategies to address health inequities that are

rooted in evidence of where inequities exist in their

communities. While there is sufficient data to identify

health inequities in Canada, the ability to evaluate

interventions is limited due to gaps in the literature.44

Because of these gaps, health care and public

health leaders often lack evidence on the impacts of

their decisions and actions on health equity.45 In the

absence of evidence on effective action, knowledge

of the pathways between the social determinants of

health and inequities — and of alternative theories of

change underpinning different approaches — can also

help entities to think through what might work, where

action should be targeted and who should be involved.

Equity-integrated population health status reporting: Action framework (2016)

The six National

Collaborating

Centres for Public

Health (NCCPH)

collaboratively

developed the

Equity-integrated

population health

status reporting:

Action framework document to support

the development of monitoring and equity

interventions.

EQUITY-INTEGRATED POPULATION HEALTH STATUS REPORTING: ACTION FRAMEWORK


Let’s Talk: Universal and targeted approaches (2013)

Our document Let’s

Talk: Universal

and targeted

approaches offers

insight on reducing

disparities all along

the socioeconomic

gradient.PART OF THE LET’S TALK SERIES

LET’S TALK

U N I V E R SA L A N D TA R G E T E D A P P R OAC H E S

TO H E A LT H E Q U I T Y

Through continuous quality improvement and

monitoring/surveillance, data can be used by public

health practitioners to demonstrate that interventions

are targeting the most disadvantaged populations —

those experiencing the greatest burden of health

inequities — and that strategies are having an impact

on specific indicators. Interventions that target the

needs of the most disadvantaged groups do not always

reach others who experience relative disadvantage as

a result of their place on the social gradient.46

Proportionate universalism recognizes that public

health programs should include a range of universal

strategies (i.e., provided to the whole population) that

are also resourced and delivered with intensity relative

to the level of social need.47 Public health leaders who

draw on their sense of social justice in combination

with data are willing to take risks and implement

strategies based on community priorities. Using this

type of decision-making process for health equity

interventions reinforces the importance of public

health leaders’ intimate connection with their

communities. It also ensures that they have a deep

understanding of the pathways linking the social

determinants of health and health inequities.

Good leaders and good followers work together

Together, good leadership and followership can build

environments that encourage trust, relationships

and positive outcomes.48 “Followers are never

powerless, because power is a relationship not a

possession”49(p16) and, therefore, the quality of the

relationships between leaders and followers matters.

Relationships support the shared and distributed

nature of public health leadership.


Followers are never powerless, because power is a relationship not a possession”49(p16) and, therefore, the quality of the relationships between leaders and followers matters.”In the same way that individuals are never only a

follower or a leader,31 followership applies at all

levels of an organization and is not restricted to

those in subordinate positions.49 Practitioners in

formal positions of authority are also followers,

not just of other levels of authority but of the very

relationships they build and nurture. Because the

distribution of power between formal and informal

leaders and followers affects the achievement of

outcomes,48 organizations are more effective when

there is a balance of followership and leadership

at all levels31 where there is a sense of collective

ownership over outcomes.

Conclusion

State of the literature and research gaps

While many features of leadership identified in the

literature may apply to a public health setting, much

of the leadership research does not consider the

unique characteristics of the public health practice

environment, how public health action for equity

depends on collaboration with health and non-health

partners, or the focus on change at a population level.

There are a number of sources on leadership theory

and development; however, there is very little literature

that looks closely at how this research applies to public

health.15,21,50 Two systematic reviews confirm a lack of

research specific to leadership within the public health

realm.42,51 One review notes that the research on public

service leadership lacks “a comprehensive theoretical”

approach and is fragmented. 51(p126)

There is even less literature that specifically considers

public health leadership to advance health equity,

the effectiveness of public health leadership on

action regarding health equity or how public health

leadership can be strengthened or developed.52,53

Despite the reality that leadership in public health

is necessary to achieve health equity,54 definitions

of public health leadership do not typically include a

commitment to addressing the social determinants

or the goal of health equity. Most of the leadership

literature comprises opinion-based secondary

sources, and several important theories relevant

to public health practice are not noticeable in the

leadership literature, such as intersectionality and

critical social theory.1

“


Future areas for research in public health leadership for health equity

There is a need for further empirical and theoretical research in the area of public health leadership for

health equity. In particular, further research would enrich the field of public health leadership by exploring the

following topics:

The relationship between management and

leadership in public health organizations

The influence of leadership on continuous

quality improvement processes to consider the

effectiveness of equity interventions on health

outcomes

The integration or use of relevant theories, such

as complexity theory, intersectionality and critical

social theory, to inform research on public health

leadership and health equity

Areas of focus for strengthening public health

leadership specific to reducing health inequities

(i.e., what works)

Relational components of public health leaders

and communities to address health equity

Definitions and descriptions of public health

leadership that specifically include the concepts

of health equity and social justice

Development of leadership knowledge and

skills at all levels of public health organizations,

including the front line and across disciplines

How leadership is developed within the

community, organizations and civil society in

partnership with public health

Followership as an area of knowledge and skill to

advance health equity


1. Betker RC. Public health leadership to advance health equity: a scoping review and metasummary. Saskatoon (SK): University of Saskatchewan; 2016. 249 p.

2. Simms C. Increasing organizational capacity for health equity work: a literature review for Health Nexus. Toronto (ON): Health Nexus; 2017. 38 p.

3. National Collaborating Centre for Determinants of Health. Integrating social determinants of health and health equity into Canadian public health practice: environmental scan 2010. Antigonish (NS): NCCDH, St. Francis Xavier University; 2011. 84 p.

4. National Collaborating Centre for Determinants of Health. Boosting momentum: applying knowledge to advance health equity: environmental scan 2014. Antigonish (NS): NCCDH, St. Francis Xavier University; 2014. 48 p.

5. Public Health Agency of Canada. Core competencies for public health in Canada: release 1.0 [Internet]. Ottawa (ON): PHAC; 2007 [cited 2016 Feb 04]. 29 p. Available from: http://www.phac-aspc.gc.ca/php-psp/ccph-cesp/pdfs/cc-manual-eng090407.pdf.

6. Betker C, Bewick D. Financing, policy and politics of healthcare delivery. In: Stamler LL, Yiu L, Dosani A, editors. Community health nursing: a Canadian perspective. 4th ed. Toronto (ON): Pearson Canada; 2016. p. 17-36.

7. Cummings G, MacGregor T, Davey M, Lee H, Wong C, Lo E, Muise M, Stafford E. Leadership styles and outcome patterns for the nursing workforce and work environment: a systematic review. Int J Nurs Stud. 2010;47(3):363-385.

8. Denis J, Langley A, Rouleau L. The practice of leadership in the messy world of organizations. Leadership. 2010;6:67-88.

9. Kouzes JM, Posner BZ. The truth about leadership. San Francisco, CA: Jossey-Bass; 2010.

10. Grossman SC, Valiga TM. The new leadership challenge: creating the future of nursing. 4th ed. Philadelphia, PA: FA Davis; 2012.

11. Kotter JP. What leaders really do. Harv Bus Rev. 1990;68(3):1-3-111.

12. Avolio B, Walumbwa F, Weber T. Leadership: current theories, research, and future directions. Annu Rev Psychol. 2009;60(1):421-449.

13. Goffee R, Jones G. Why should anyone be led by you? Harv Bus Rev. 2000;78(5):62-70.

14. Zaccaro S. Trait-based perspectives of leadership. Am Psychol. 2007;62(1):6-16.

15. Begun JW, Malcolm JK. Leading public health: a competency framework. New York (NY): Springer Publishing Company; 2014.

16. Koh H. Leadership in public health. J Cancer Educ. 2009;24(S2):11-18.

17. Dickson GS. The pan-Canadian health leadership capability framework project: a collaborative research initiative to develop a leadership capability framework for healthcare in Canada. Final report submitted to Canadian Health Services Research Foundation. Ottawa (ON): Canadian Foundation for Healthcare Improvement; 2007. 21 p.

18. Koh H. Navigating government service as a physician. Health Educ Behav. 2016;43(1):7-10.

19. Smith T, Stankunas M, Czabanowska K, de Jong N, O’Connor S, Fowler-Davis S. Principles of all-inclusive public health: developing a public health leadership curriculum. Public Health. 2015;129(2):182-184.

20. Kotter JP, Schlesinger LA. Choosing strategies for change. Harvard Business Review. 2008;86(7/8):130-139.

21. Rowitz L. Public health leadership. 3rd ed. Burlington (MA): Jones & Bartlett; 2014.

22. Koh HK, Jacobson M. Fostering public health leadership. J Public Health. 2009;31(2):199-201.

23. Moodie R. Learning about self: leadership skills for public health. J Public Health Res. 2016;5(1):1-6.

24. Gardiner JJ. Transactional, transformational, and transcendent leadership: metaphors mapping the evolution of the theory and practice of governance. Leadersh Rev. 2006;6(2):62-76.

25. Kouzes JM, Posner BZ. The leadership challenge: how to make extraordinary things happen in organizations. 5th ed. San Francisco (CA): Jossey-Bass; 2012.

26. Uhl-Bien M, Marion R, McKelvey B. Complexity leadership theory: shifting leadership from the industrial age to the knowledge era. Leadersh Q. 2007;18(4):298-318.

27. Burns JM. Leadership. New York, NY: Harper & Row; 1978.

28. Falk-Rafael A, Betker C. The primacy of relationships: a study of public health nursing practice from a critical caring perspective. ANS Adv Nurs Sci. 2012;35(4):315-332.

29. Kelley R. In praise of followers. Harv Bus Rev. 1988;66(6):142-148.

30. Nowell B, Harrison L. Leading change through collaborative partnerships: a profile of leadership and capacity among local public health leaders. J Prev Interv Community. 2011;39(1):19-34.

31. Srinivasan J, Holsinger J. The yin-yang of followership-leadership in public health. J Public Health. 2012;20:95-98.

32. Suda LV. In praise of followers (2nd ed.). PM World Journal. 2014;III(II):1-11.

33. Gardner JW. On leadership. New York, NY: Free Press; 1990.

34. Yphantides N, Escoboza S, Macchione N. Leadership in public health: new competencies for the future. Front Public Health. 2015;3:1-3.

REFERENCES


35. Baum F. Cracking the nut of health equity: top down and bottom up pressure for action on the social determinants of health. Glob Health Promot. 2007;14:90-95.

36. Baum F, Bégin M, Houweling TAJ, Taylor S. Changes not for the fainthearted: reorienting health care systems toward health equity through action on the social determinants of health. Am J Public Health. 2009;99(11):1967-1974.

37. Koh H, Nowinski J. Health equity and public health leadership. Am J Public Health. 2010;100(S1):S9-S11.

38. Community Health Nurses of Canada. Leadership competencies for public health practice in Canada: leadership competency statements. Version 1.0. St. John’s (NL): CHNC; 2015. 2 p.

39. Cunliffe A, Eriksen M. Relational leadership. Hum Relat. 2011;64(11):1425-1449.

40. Community Health Nurses of Canada and National Collaborating Centre for Determinants of Health. Public health nursing leadership development in Canada. St. John’s (NL): CHNC and NCCDH; 2013. 62 p.

41. Kilmann RH, O’Hara LA, Strauss JP. Developing and validating a quantitative measure of organizational courage. J Bus Psychol. 2009. 9 p.

42. Vogel R, Masal D. Public leadership: a review of the literature and framework for future research. J Public Manage Rev. 2015;17(8):1165-1189.

43. Pittman M. Leadership for the public’s health: legacy of the healthy communities movement. Natl Civ Rev. 2013;102(4):17-19.

44. National Collaborating Centre for Determinants of Health. Common agenda for public health action on health equity. Antigonish (NS): NCCDH, St Francis Xavier University; 2016. 38 p.

45. Sadana R, Blas E. What can public health programs do to improve health equity? Public Health Reports. 2013;128(suppl 3):12-20.

46. National Health Service Scotland. Proportionate universalism and health inequalities. [location unknown]: NHS Scotland; 2014. 6 p.

47. Marmot M, Allen J, Bell R, Bloomer E, Goldblatt P. WHO European review of social determinants of health and the health divide. Lancet. 2012;380(9846):1011-1029.

48. Whitlock J. The value of active followership. Nurs Manage. 2013;20(2):20-23.

49. Grint K, Holt C. Followership in the NHS. London (UK): The King’s Fund Commission on Leadership and Management in the NHS; 2011. 22 p.

50. Carlton EL, Holsinger JW, Jr., Riddell MC, Bush H. Full-range public health leadership, part 1: quantitative analysis. Front Public Health. 2015;3(73):1-8.

51. Chapman C, Getha-Taylor H, Holmes M, Jacobson W, Morse R, Sowa J. How public service leadership is studied: an examination of a quarter century of scholarship. Public Adm. 2016;94(1):111-128.

52. Catford J. Developing leadership for health: our biggest blindspot. Health Promot Internation. 1997;12(1):1-4.

53. Hannaway C, Plsek P, Hunter DJ. Developing leadership and management for health. In: Hunter DJ, editor. Managing for Health. London (UK): Routledge; 2007. p 148-172.

54. Butler-Jones D. The Chief Public Health Officer’s report on the state of public health in Canada, 2008: addressing health inequalities. Ottawa (ON): Public Health Agency of Canada; 2008. 102 p.

NATIONAL COLLABORATING CENTRE FOR DETERMINANTS OF HEALTH

St. Francis Xavier University Antigonish, NS B2G 2W5tel: (902) 867-6133 fax: (902) 867-6130

email: [email protected] web: www.nccdh.ca

Documents

PUBLIC HEALTH LEADERSHIP FOR ACTION ON HEALTH EQUITY: …nccdh.ca/images/uploads/comments/Public_health_leadership_for_a… · Public health leadership is defined by the Public Health